Hepatic and cardiac necrosis in a patient with prostatic carcinoma given 6-aminocaproic acid

The pathological findings in a case of prostatic carcinoma with fibrinolysin, treated with epsilon-aminocaproic acid, included hepatic and cardiac necrosis. The possibility is discussed that the latter lesions may be a complication of epsilon-aminocaproic acid therapy or produced by the proteolytic action of the fibrinolysin.

Studies on digitalis. VI. Reduction of the oxygen debt after exercise with digoxin in cardiac patients without heart failure

Three patients with acquired valvular heart disease and cardiac enlargement who were able to perform normal everyday activity without difficulty in the absence of digitalis therapy were exercised while receiving a placebo and again while receiving digoxin. Digoxin administration did not produce a significant change in body weight or in the subjective condition of the individuals. Varying degrees of exercise were performed on a treadmill in a Metabolic Chamber and oxygen consumption was measured cotinuously before, during, and after the period of exercise, utilizing a continuous gas flow paramagnetic oxygen analyzer. The oxygen debt that developed during digoxin administration was compared to that observed during placebo administration.

In all patients the oxygen debt was smaller during the period of digoxin administration, although the external work performed was identical. In the first patient, following a 7-minute walk, the oxygen debt was 53 per cent more and following a 10-minute walk it averaged 40 per cent more while not receiving digoxin than when receiving this drug. In the second subject the oxygen debt following a 7-minute walk was 34 per cent more and following 10-minute walk it averaged 74 per cent more when he was not receiving digoxin than when receiving this drug. In the third subject the oxygen debts were 46 per cent and 41 per cent greater following 10- and 15- minute walks respectively, when she was not receiving digoxin.

The accumulation of a smaller oxygen debt following exercise while these subjects were receiving digoxin indicates that the functional status of their circulatory system was improved by the drug. It would appear that digitalis administration is beneficial to at least some patients who have cardiac disease and enlarged hearts and some decrease in cardiac reserve without signs or symptoms of heart failure.

HEMODYNAMICS DURING THE CHRONIC STAGE OF MYOCARDIAL DAMAGE CAUSED BY ISOPROTERENOL

Cardiovascular measurements were performed in rats 3–4 days, 1 week, 2 weeks, 5–6 weeks, and 4–5 months after the subcutaneous injection of 40 mg/kg isoproterenol on two consecutive days. Up to 1 week after the injections severe histological damage of the myocardium was accompanied by cardiac enlargement and impaired function: blood pressure, cardiac output and work were in the normal range under basal conditions but the maximum cardiac output and work measured during infusion of polyvinylpyrrolidone into the right side of the heart were well below normal. During the following weeks histological repair took place and the cardiovascular parameters measured were not different from those found in normal rats. This period was followed by a third stage which occurred without further interference with the heart. It consisted of thinning of the ventricular wall and aneurysm formation. All cardiovascular values (maximum and basal as well) were below normal without development of cardiac enlargement.

STUDIES ON STARLING'S LAW OF THE HEART. IX. THE EFFECTS OF IMPEDING VENOUS RETURN ON PERFORMANCE OF THE NORMAL AND FAILING HUMAN LEFT VENTRICLE

The acute circulatory responses to impeding venous return to the heart by the inflation of a balloon in the inferior vena cava were determined in 14 patients undergoing left heart catheterization. In the five patients without clinical or hemodynamic evidence of impaired left ventricular function, left ventricular end-diastolic pressure fell, and the decrease was accompanied by reductions in the cardiac index, left ventricular stroke volume, and left ventricular stroke work. In nine patients with impaired left ventricular function, directionally similar responses were noted, although the left ventricular function curves relating left ventricular end-diastolic pressure to left ventricular stroke work were generally flatter and lower than those in the patients without left ventricular disease. In none of the patients did a significant increase in cardiac index, stroke volume, or left ventricular stroke work occur during inflation of the balloon. It is concluded that the Starling relationship appears to operate in a directionally similar manner both in the normal and the depressed human left ventricle, and that the left ventricles of patients with impaired function are not on a descending limb of the curve. However, a descending limb of the left ventricular Starling curve may become apparent when an additional work load is imposed on the diseased ventricle.

SEVERE MITRAL REGURGITATION SECONDARY TO RUPTURED CHORDAE TENDINEAE

Fifteen cases of severe mitral regurgitation secondary to ruptured chordae tendineae have been reviewed, eight of whom underwent open-heart surgery to correct their lesions. Three patients are living at this time with two being markedly improved. Cardiac catheterization was performed in six prior to surgery.

Progressive deterioration within the year following the onset of difficulty or sudden worsening of previous cardiac symptoms characterized the usual clinical course. The apical systolic murmur, always loud, was conspicuously harsh and radiated to the base of the heart, simulating aortic stenosis when the mural cusp was ruptured. Although strongly suggesting the diagnosis, the sudden onset of an apical systolic murmur could be documented in only three instances. The presence of a small left atrium radiographically with tall left atrial "v" waves and marked reflux of contrast material into a paradoxically pulsating left atrium also pointed to the correct diagnosis.

Various technics of surgical repair and problems influencing survival of patients in the present series are discussed.

BUNDLE-BRANCH BLOCK: AN EPIDEMIOLOGIC STUDY

As part of an inclusive health examination of the population of Tecumseh, Michigan, electrocardiograms were recorded from 8,641 persons of all ages, 87.9 per cent of those living in the study area. Eighteen persons, twelve men and six women, had complete right bundle-branch block and a like number, composed of six men and 12 women, had left. All affected persons were past 20 years of age and 67 per cent were past 60.

Twenty-five of the 36 persons had no clinical evidence of valvular heart disease, angina pectoris, or myocardial infarction.

Bundle-branch block occurred mostly in the older age groups where there was a high prevalence of hypertension, hypercholesteremia, hyperglycemia, and obesity, although these conditions were no more frequent among the affected persons than among others of the same age and sex.